Provider Demographics
NPI:1528040763
Name:PABLOS, YAIDI (MD)
Entity Type:Individual
Prefix:
First Name:YAIDI
Middle Name:
Last Name:PABLOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9546 CALLE DIAZ WAY
Mailing Address - Street 2:APT 910
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1410
Mailing Address - Country:US
Mailing Address - Phone:787-392-9311
Mailing Address - Fax:
Practice Address - Street 1:716 AVE PONCE DE LEON
Practice Address - Street 2:OFICINA 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-4503
Practice Address - Country:US
Practice Address - Phone:787-764-6870
Practice Address - Fax:787-764-6870
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C79563Medicare UPIN
0026618Medicare ID - Type Unspecified